Evaluation of bronchial constriction in children with cystic fibrosis after inhaling two different preparations of tobramycin

Chest. 2002 Sep;122(3):930-4. doi: 10.1378/chest.122.3.930.


Objectives: This randomized, double-blind, cross-over study evaluated the risk of bronchoconstriction with two preparations of inhaled tobramycin in children with cystic fibrosis (CF) infected with Pseudomonas aeruginosa with and without airway hyperreactivity.

Design: Of 19 children with CF (age range, 7 to 16 years) with mild-to-moderate pulmonary disease, 10 children were at high risk (HR) for bronchospasm (family history of asthma and previous response to bronchodilators) and 9 children were at low risk (LR) for bronchospasm (no family history of asthma or previous response to bronchodilators). Two solutions of tobramycin were administered: (1) 80 mg in a 2-mL vial diluted with 2 mL of saline solution containing the preservatives phenol and bisulfites (IV preparation); and (2) 300 mg in a preservative-free preparation in a 5-mL solution. Following a bronchodilator-free period of 12 h, the patients inhaled either one or the other preparation in random order on two different occasions, 2 weeks apart.

Results: Prechallenge and postchallenge results for the LR group showed a percentage of fall in FEV(1) (DeltaFEV(1)) of 12 +/- 9% (mean +/- SD) for the IV preparation, compared to 4 +/- 5% for the preservative-free preparation (p = 0.046). An DeltaFEV(1) of > 10% was seen in six of nine patients for the IV preparation and in one of nine patients for preservative-free preparation. For the HR group, the DeltaFEV(1) was 17 +/- 13% for the IV-preparation group, compared to 16 +/- 12% for the preservative-free group (p = 0.4). In this group, equal numbers of patients (8 of 10 patients) had an DeltaFEV(1) > 10% after inhaling each preparation. The largest DeltaFEV(1) was 44% (HR group with the preservative-free preparation that forced the early termination of inhalation).

Conclusions: Both preparations caused significant bronchoconstriction in the HR group, and the preservative-containing IV preparation caused more bronchospasm in LR group than the preservative-free solution. Heightened airway reactivity in children with CF places them at risk of bronchospasm from inhalation therapy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Bronchial Hyperreactivity / drug therapy
  • Bronchoconstriction / drug effects*
  • Child
  • Cross-Over Studies
  • Cystic Fibrosis / drug therapy*
  • Double-Blind Method
  • Female
  • Forced Expiratory Volume / drug effects
  • Humans
  • Male
  • Pneumonia, Bacterial / drug therapy*
  • Preservatives, Pharmaceutical / adverse effects
  • Pseudomonas Infections / drug therapy*
  • Pseudomonas aeruginosa*
  • Risk Factors
  • Spirometry
  • Tobramycin / administration & dosage*
  • Tobramycin / adverse effects


  • Preservatives, Pharmaceutical
  • Tobramycin